Healthcare Provider Details

I. General information

NPI: 1205813029
Provider Name (Legal Business Name): L A GOODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 SAINT JOHN DR
NASSAU BAY TX
77058-6302
US

IV. Provider business mailing address

714 FM 1960 RD W SUITE 206
HOUSTON TX
77090-3405
US

V. Phone/Fax

Practice location:
  • Phone: 281-333-5503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberF2689
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: